Multivitamin supplementation in oral contraceptive users.

The effects of oral contraceptives (OC) containing 30 micrograms of ethinyl oestradiol and of subsequent multivitamin and folic acid supplementation on vitamin A, total B2 [including its three individual constituents, i.e. riboflavine, RB; flavine-mono-nucleotide, FMN; and flavine-adenine-dinucleotide, FAD], B12, C and folate concentration in serum and red blood cells have been studied in a group of 59 non-pregnant female volunteers. The group taking OC comprised 28 women while 31 women were included in the group of non-OC users serving as the controls. The women were studied for four cycles. Blood samples were taken on days 3 and 23 of the first cycle to obtain baseline values of each analyte. Multivitamin and folic acid supplementation started on day 1 of the second cycle and this was continued daily throughout three consecutive cycles until the end of the study. Vitamin A levels were significantly higher and vitamin B12 levels were significantly lower in the group using OC. Comparison of the baseline values of vitamin total B2, FAD, C, serum and red blood cell folate as determined on days 3 and 23 of the first cycle of the two groups compared revealed no significant differences. Multivitamin and folic acid supplementation did not affect the concentrations of vitamin A and vitamin B12 with either group, whereas all other vitamins increased significantly in both groups. The consistency of each effect of multivitamin supplementation between the two groups was also tested. The degree of these effects was not statistically different between both groups. The results suggest that the vitamin status is indeed affected by OC treatment, but the effects of multivitamin supplementation are not different in OC and non-OC users. Supplementation during OC use or just after discontinuing treatment cannot be justified for healthy young women. However, in the case of women with a critical vitamin balance or higher folate needs, multivitamin supplementation may be considered.

Protein/creatinine ratio in the assessment of proteinuria during pregnancy.

Since the nature and the level of urinary protein excretion have considerable clinical implications in the course of pregnancy, the early detection of even minor degrees of hyperproteinuria is important. Quantitation of 24-h urinary protein excretion is the only definite method of establishing the presence of hyperproteinuria, but this method shows practical failures particularly in an outpatient setting. Dipstick analysis as a screening for hyperproteinuria also lacks reliability, since the normal rate of protein excretion in primigravid pregnancy has recently been shown to be less that 150 mg per day. In this study, therefore, we propose the determination of the protein/creatinine ratio in a single voided urine sample, obtained during normal daylight activity, as a screening test for hyperproteinuria during pregnancy which can replace the quantitation of 24-h urinary protein excretion.

Intracranial pressure and fetal heart rate in a hydrocephalic fetus during labor.

Intra-uterine pressure (IUP), intracranial pressure (ICP) and fetal heart rate (FHR) were simultaneously recorded during labor in a severely hydrocephalic fetus. After cephalocentesis, 600 ml of liquor cerebrospinalis was drained. ICP exceeded IUP, but the increase in ICP was less than the increase in IUP during most of the contractions. The FHR showed marked decelerations during uterine contractions and changed gradually into a persistent bradycardia. The pathophysiology of fetal heart rate patterns during labor is discussed and the literature has been reviewed.

Disturbed reproductive performance in extreme folic acid deficient golden hamsters.

We studied the effects of folic acid-deficient diets on maternal red blood cell folate level and reproductive performance in golden hamsters (Mesocricetus auratus, Waterhouse). Animals on the same day of oestrous cycle were put together and finally divided into three groups. Each group comprised at least 12 mature female hamsters. The animals were given three different diets, which were commenced before mating. The feeding regimens comprised a standard diet (group 1), or a folic acid-deficient diet which started either 2 weeks (group 2) or 16 weeks (group 3) prior to mating. The regimens were continued until sacrifice of the animals on day 9 of pregnancy. Pregnancy was realized by caging a male with a selected female during the night of ovulation. Just prior to sacrifice, blood samples were drawn to measure maternal folic acid levels in red blood cells. The pregnant uteri were removed and the embryonic sacs were carefully dissected away from the uterus. The number of sacs per pregnant animal was noted. Extreme folic acid deficiencies were confirmed in the pregnant golden hamsters on a folic acid-deficient diet which started 16 weeks prior to mating as compared to those on a standard diet and on a folic acid-deficient diet which started 2 weeks prior to mating. This deficiency appears to interfere with normal reproductive performance. It caused early embryonic loss several days after mating and resulted, finally, in restoration of the oestrous cycle.

Aortic valve replacement in the second trimester of pregnancy: a case report.

A 36 year old woman with left heart failure and right-sided hemiparesis due to endocarditis of the aortic valve underwent urgent aortic valve replacement during the 24th week of gestation. High-flow high-pressure normothermic perfusion during cardiopulmonary bypass was performed. Peri-operative fetal heart rate and uterine contractions were monitored. Severe fetal heart rate decelerations and loss of variability as well as uterine contractions were observed during surgery. Uterine contractions were treated medically. Pregnancy was carried to term and a healthy baby was delivered vaginally. The effect of the nonpulsating cardiac pump during extracorporeal circulation on the fetus will be discussed. Recommendations for the peri-operative management of the fetal unit are made.

The effects of periconceptional folic acid and vitamin supplementation on maternal folate levels and on neurulating hamster embryos in vivo.

We studied the effects of periconceptional oral supplementation of folic acid and vitamins on the maternal red blood cell (RBC) folate level of golden hamsters (Mesocricetus auratus, Waterhouse). The effects of folate deficiency and supplementation on the process of neurulation and the incidence of resorptions were evaluated. Groups of at least eleven mature virgin female hamsters were placed on one of six specific regimens which started two weeks prior to mating and continued until sacrifice on day nine of pregnancy. Just prior to sacrifice, blood samples were drawn by cardiac puncture to measure maternal folic acid levels in red blood cells. The staging of the embryos was based on O'Rahill's modification of Streeter's developmental horizons in human embryos. Considerable variation was observed in the stage of embryonic development of 9-day-old hamster embryos, both between littermates and between litters of the same gestational age. A high overall incidence of open neural tubes was observed, which did not reflect neural tube closure failures. A folate-free diet caused retardation of the embryonic development, although maternal folate levels were unaffected (p < 0.01). The RBC folate levels in the animals which received oral supplementation with folic acid was significantly higher than that in the unsupplemented controls (p < 0.001). Folic acid supplementation alone increased the RBC folate level significantly more than combined supplementation with multivitamins (p < 0.001). The data indicate that oral supplementation with folic acid and/or multivitamins produce adequate maternal RBC folate levels. An inadequate maternal folate intake can affect the growth of neurulating embryos even if the maternal RBC folate levels are still sufficient.(ABSTRACT TRUNCATED AT 250 WORDS)

Emergency aortic valve replacement in the 24th-week of pregnancy.

The incidence of heart disease during pregnancy has declined from 3.6% to approximately 1.5% over the last 25 years as a result of better medical and surgical care. Rheumatic heart disease still accounts for 75% of cases and the incidence of bacterial endocarditis during pregnancy is about 1 in 8000. Seaworth and Durack reviewed 124 cases found in the literature of a 40 year period. The experience of any anesthetist with such cases will thus be limited. In this case report a patient is described who required emergency aortic valve replacement in the 24th week of pregnancy. The effect of the non-pulsatile flow during the extracorporeal circulation on the foetal unit will be discussed. Recommendations for the perioperative management include a normothermic high flow, high pressure perfusion technique, monitoring of foetal heart rate and uterine activity and vigorous tocolysis using beta sympathomimetics and progesterone.

The effects of oral contraceptives and multivitamin supplementation on serum ferritin and hematological parameters.

We have studied the effects of oral contraceptive (OC) use and of subsequent multivitamin supplementation on several hematological parameters. Hemoglobin (Hb), hematocrit (Ht), mean corpuscular volume (MCV), mean corpuscular hemoglobin concentration (MCHC), mean corpuscular hemoglobin (MCH), and serum iron status (serum iron, total iron binding capacity and ferritin) were tested in groups of women with and without OC in view of preconceptional status. The group taking sub-50 OC comprised 28 women while 31 women were included in the group of non-OC users. Blood samples were taken on days 3 and 23 of the first cycle to obtain baseline values of each analyte. Multivitamin supplementation started on day 1 of the second cycle and this was continued daily throughout three consecutive cycles until the end of the study. Comparison of the baseline values of each parameter as determined on days 3 and 23 of the first cycle of the two groups revealed no significant different hematological parameters due to OC-use unlike the parameters of serum iron status which were all significantly increased for the group of OC-users as compared to the group of non-OC users. The effects of multivitamin supplementation on the hematological and iron status parameters were studied within each group. The consistency of each effect of multivitamin supplementation between the two groups was also tested. A multivitamin supplementation significantly decreased MCHC within either group, and caused increases of MCV, whereas Ht and MCH remained unaltered. With respect to the iron balance, serum iron and total iron binding capacity significantly increased, whereas serum ferritin decreased during multivitamin supplementation.(ABSTRACT TRUNCATED AT 250 WORDS)

Prepregnancy care and prevention of birth defects.

Birth defects and disturbances in growth and development need an increasing attention in perinatal medicine. It is remarkable that so little attention has been paid to the pathogenesis of malformations in the literature in an approach to find aspects of prevention. Primary prevention of birth defects is an important public health issue as malformations have important consequences both for society and the individuals concerned. Prepregnancy care as a logical precursor to antenatal care, offers risk-assessment, advice and occasionally treatment before pregnancy, in order to avoid congenital malformations. It is therefore that we started a research program with emphasis on primary prevention of congenital malformations. In this respect medication, maternal nutritional status, diabetes mellitus and neural tube defects are discussed.

Periconceptional vitamin profiles are not suitable for identifying women at risk for neural tube defects.

Folic acid and other vitamin deficiencies may play a role in the etiology of neural tube defects. The Medical Research Council Vitamin Study confirmed the beneficial effect of folic acid supplementation on the prevention of neural tube defects. However, the concentrations of vitamins other than folate were not a common feature of any of the former studies. We measured the concentrations of vitamin A, riboflavin, riboflavine-5'-monophosphate, flavine-adenine-dinucleotide, vitamin B-6, vitamin B-12, vitamin C, vitamin E, folate and ferritin in the serum of women who had previously had a child with a neural tube defect and were planning a further pregnancy. Vitamin and folic acid supplements were supplied before conception to 44 high risk women before conception. Eighteen other high risk women not given supplements were the control group. We concluded that vitamin profiles do not form a suitable means for identifying women at risk for neural tube defects before pregnancy. This endorses the hypothesis that the beneficial effect of folic acid supplementation on the prevention of neural tube defects is possibly at least partly due to the fact that it overrides a relative folic acid shortage caused by a metabolic disorder.